DPT835: Health, Wellness, and Nutrition - Exam 2 Review Material

describe individual-focuses program planning for health promotion and give examples

-promoting the health of individual patients especially when that health issue relates to current health concerns unrelated to the primary reason for the visit

-individual-focused interventions are also population-based especially when that health issue ensures the health of the community or helps change the subjective norm of the community

-ex. worksite exercise prescriptions for at-risk employees, referral of patients for nutritional and behavioral counseling

describe community-focused program planning for health promotion and give examples

-designed to effect changes the health or health behaviors of a particular community or subgroup w/in a community (residents of a particular neighborhood, community members who are in a particular age group, diagnostic group, etc., employees of a particular business, school, healthcare system, etc.)

-ex. school-based consultation re. physical activity programs, participation in professional association advertising campaigns to promote physical activity

describe systems-focused program planning for health promotion and give an example

-designed to effect changes in organizations, policies, and laws that will improve the health of populations

-ex. advocacy to increase neighborhood and city walkability

define/explain the screening and outreach population based intervention method and provide an example

-identifies individuals with unrecognized health risk factors or asymptomatic disease conditions in populations and locates populations-of-interest or populations-at-risk and provides information about the nature of the concern, what can be done about it, and how services can be obtained

-ex. falling risk screening

define/explain the referral and follow-up population based intervention method and provide an example

-assists individuals, families, groups, organizations, and/or communities to identify and access necessary resources to prevent or resolve problems or concerns

-ex. family violence referral, referral of patients for nutritional and behavioral counseling

define/explain the health teaching and coaching population based intervention method and provide an example

-communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities and establishes an interpersonal relationship with a community, a system, and family or individual intended to and increase or enhance their capacity for self-care and coping

-ex. tobacco cessation coaching, worksite exercise prescriptions for at-risk employees

define/explain the consultation and collaboration population based intervention method and provide an example

-seeks information and generates optimal solutions to perceived problems or issues through interactive problem solving with a community, systems, and family or individual

-the community, system, and family or individual select and act on the option best meeting the circumstances

-commits two or more persons or organization to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health

-ex. designing safe cycling areas, school-based consultation re. physical activity programs

define/explain the advocacy and policy development population based intervention method and provide an example

-places health issues on decision-makers' agendas, acquires a plan of resolution, and determines needed resources

-policy development results in laws, rules and regulation, ordinances, and policies

-pleads someone's cause or acts on someone's behalf, with a focus on developing the community, system, and individual or family's capacity to plead their own cause or act on their own behalf

-ex. direct access for PT services, advocacy to increase neighborhood and city walkability

define/explain the social marketing population based intervention method and provide an example

-utilizes commercial marketing principles and technologies for programs designed to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population-of-interest

-ex. APTA choosePT campaigns, participation in professional association advertising campaigns to promote physical activity

what are potential issues that can influence teaching and learning via individualized instruction

-primary language

-available resources

-literacy skills

-physical abilities

-cultural and socioeconomic factors

-emotional issues

-locus of control

what are low literacy skills associated with and what are signs of low literacy skills

-low literacy skills are associated with poor health and lead to decreased adherence to tx

-s/s: take words literally, skip uncommon words, tire easily with written info, guess, do not ask questions

what strategies can help address low literacy skills

use a variety of methods, videos, demonstrations, verbal explanations, pictures; ask for comprehension; decrease distractions; chunk information into manageable bits

what are the 3 types of learning styles and provide examples

-auditory learner: learn by listening (lectures)

-visual learner: learn by watching (video or slide presentation, observation)

-kinesthetic learner: learn by doing (pro bono clinic; interact in a discussion; laboratory class; practice a skill hands-on)

what are some benefits for group teaching

-efficient

-share info and experience b/t group members

-brainstorming issues and solutions

-shared thinking

-challenging assumptions and myths held by individuals

what are disadvantages/challenges of group teaching

-time and energy

-group participation

-group conflict

-poor leadership

-unclear goals

what are different group types (7) and define them

-primary group: fam/friends, affection/support

-social groups: share common interests

-self-help groups: all mems share same issue (AA)

-learning groups: mems acquire info on a topic

-service groups: help others, often associated with a cause

-work groups: groups that form at work to achieve tasks

-public groups: groups that work for public (school boards)

what are effective group norms/rules that groups abide by (7)

-start and end time

-talking time

-rules for being recognized to speak

-use of names

-break times

-learning contracts

-confidentiality

what are benefits of verbal instructions as a teaching method

primary language, education level, comprehension, use of jargon

what are benefits of written instructions as a teaching method

literacy, different levels of flexibility depending on prefabricated format

what are the benefits of action/simulation as a teaching method

actually performing the task, provides a sage environment where trial and error reinforce learning

what are some design considerations when designing a poster display

-use attractive color combos, attention grabbing, avoid crowded wording, consider spacing and balance

succinct text, logical flow, no more than 10 words in the title, text large enough to be read ~4-6 feet away, avoid ALL CAPS, field test w/ target population

define pain

an unpleasant sensory and emotional experience associated with, or resembling that associated with, actuarial or potential tissue damage

what factors influence pain sensitivity (5)

-sex and gender

-ethnicity or race

-psychological factors

-age-related considerations

-heredity and genetics

define fear

distressing negative feelings associated with a perceived threat

define fear avoidance

avoiding what you are scared of by altering your typical daily activities or mechanics; avoiding the perceived threat

define pain catastrophizing

excessive thought of increasing pain; inability to foresee any other outcomes besides a negative one

define yellow flags

caution, usually attached to psychosocial aspects

how do we get a behavior change in association with pain

-transtheorectical theory (precontemplation -> contemplation -> preparation -> action -> maintenance)

-pt buy-in

-individuals who reject the message at first --> a behavior change is predeced by an emotional response

what are 3 essential things regarding motivational interviewing

-it is a convo about change

-it is collaborative

-it will ask those to call up ones own motivation and commitment

what should you do if you do have patient buy-in (regarding pain)

-slowly phase out therapy, set appropriate boundaries, pacing and graded exposure (both activities and education), provide pt w/ education plus a program that focuses on function AND goal setting, sleep hygiene, aerobic exercise

what are recommended sleep guidelines for school-age children, teens, adults, and older adults

-school age children: 10-11 hrs

-teens: 8.5 - 9.5 hrs

-adults: 7-9 hrs

-older adults: 7-8 hrs

define sleep deprivation

a condition characterized by inadequate or insufficient sleep sustained over a period of time, it occurs when an individual consistently fails to obtain the amount of sleep that they need

define insomnia and its dx criteria

-an individual's perception that sleep quality is inadequate or nonrestorative, despite having the opportunity to sleep

-includes at least one of the following: difficulty falling asleep, sleeping too lightly, being easily disrupted with multiple spontaneous awakenings, early morning awakenings with an inability to fall back asleep

define transient insomnia, short-term insomnia, and chronic insomnia

-transient insomnia: lasts less than 1 week

-short-term insomnia: lasts 1 - 6 months, typically associated with persistent, stressful situations (e.g. death or serious illness of a loved one, environmental factors, etc.)

-chronic insomnia: lasts more than 6 months

what are sleep disturbances and sleeplessness associated with

-DM, CVD (including high BP), obesity and/or abnormalities in metabolism, high cholesterol levels, depression and anxiety, daytime sleepiness and disruption or impairment of daily functioning, memory problems

-higher rates or accidents (car accidents, falls, broken bones) and work errors

describe positive stress and give an example

-normal and essential part of healthy development

-brief increases in heart rate and BP

-mild elevations in hormonal levels

-ex. tough test at school, playoff game

describe tolerable stress and give an example

-bodys alert systems activated to a greater degress

-activation is time-limited and buffered by caring adult relationships

-brain and organs recover

-ex. death of loved one, divorce, natural disaster

describe toxic stress and give an example

-occurs w/ strong, frequent or prolonged adversity

-disrupts brain architecture and other organ systems

-increased risk of stress-related disease and cognitive impairment

-ex. abuse, neglect, caregiver substance abuse

what are the concerns with medication adherence

-~⅓ of adults take 5 or more different meds (polypharmacy)

-⅓ to ½ of patients with chronic conditions do not take meds appropriately

-Confusing directions

-Inappropriate use may result in: significant adverse effects, fatalities, ineffective disease mgmt

what are warning signs associated with anorexia

drastic weight loss, wearing of baggy or layered clothing, excessive exercise, avoidance of food-related social activities

what are warning signs associated with bulimia nervosa

excessive concern about weight, bathroom visits after meals (long duration, water running continuously), strict dieting/large binges, depressive mood, increased criticism of body

what are physical signs of an eating disorder

pulse rate ~40-50 bpm, history of fainting, parotid swelling ("chipmunk cheeks"), erosion of tooth enamel

what are guidelines for approaching someone you suspect may have an ED

-Best person to approach is someone with a solid and positive relationship

-Approach in a relaxed manner, privately

-Use "I statements"

-Supportive, not judgmental, not accusatory

-Use terms like "well-being" rather than "disorder" or "sickness"

-Avoid "bingeing," "fasting," "purging"

-Ask if they would like help rather than trying to diagnose them

-Provide contact information for other supports / organizations

what should a comprehensive fall prevention program for older adults include (8)

-identification of individual risk factors that contribute to falls

-dentification of the environmental factors that contribute to falls

-Determining factors associated with the movement by the individual (e.g. reaching, lifting, walking, or turning)

-Properly managing medications and other health supplements

-improving physical mobility through exercise programs, balance, gait training, and appropriate use of walking aids

-educating family members about risk factors

-continence promotion and toileting programs

-addressing any other factors that could potentially contribute to falls

what are elements of an effective program for evaluating and addressing musculoskeletal concerns in workplaces (7)

-looking for signs of a potential musculoskeletal problem in the workplace

-Showing mgmt commitment in addressing possible problems and encouraging worker involvement in problem-solving activities

-offering training to expand management and worker ability to evaluate potential musculoskeletal problems

-Gathering data to identify problematic conditions using injury and illness logs, medical records, and job analyses

-identifying effective controls for tasks that pose a risk of musculoskeletal injury and evaluating various approaches to determine their effectiveness in injury prevention

-Establishing health care management to emphasize the importance of early detection and treatment of musculoskeletal disorders

-Minimizing risk factors for musculoskeletal disorders when planning new work processes and operations because it is less costly to build than to redesign or retrofit later

define safe patient handling and OSHA recommendations for proper patient handling

-"refers to policies and programs that enable health care workers to move patients and clients in a way that does not cause strain or injury"

OSHA recs:

-Minimize or eliminate manual lifting of patients when feasible

-workplace ergonomics teams should identify problems, implement solutions, address injury reports, provide training, and evaluate ergonomic efforts

what nutrition/diet is associated with reduced risk of developing dementia

"Heart-healthy diet" emphasizing fruits, vegetables, whole grains, fish, chicken, nuts, legumes, and healthy fats (olive oil)

how is growth measures and define maturation. what is their relationship with e/o

-growth: measured by size, physique, and body composition

-maturation: the progress toward mature state/adulthood

-the timing and tempo of growth and maturation can vary by as much as 6 years for children of identical chronological age due to the different stage of developmental status

describe the difference in development of muscular strength b/t girls and boys

-girls: strength increases linearly to ~15 years followed by a less obvious adolescent growth spurt (compared to boys)

-boys: strength increases linearly with age from early childhood to ~13 years, followed by acceleration with the adolescent growth spurt

what what age is 90% of peak skeletal mass achieved

18

when do girls accumulate 1/3 of their total skeletal mineral content

in the 3-4 years after the onset of puberty

describe the bone bank account

greater BMD at puberty may help prevent osteoporosis later in life

describe the differences in development of speed, balance, flexibility, power and muscular strength b/t girls and boys

-girls: performance increases until ~age 14, followed by minimal improvement

-boys: peak in development of static arm strength, power, and muscle endurance ~6 months-1 year after reaching peak height velocity (PHV = 13-14 years in boys)

describe the differences in the development of aerobic power (VO2max/min) b/t girls and boys

-girls: plateaus ~13-14 years old (development likely reflects changes in body composition, not aerobic function)

-boys: increases from childhood through adolescence

what are some exercise considerations for pediatrics

-children have immature thermoregulatory systems --> increased heat gain/loss from environment, lower capacity to perspire, higher risk for dehydration

-avoid temp extremes, allow more time to acclimatize

-emphasize maintenance of healthy behaviors

what is the healthy people 2030 goals for PA in peds

-Do enough aerobic physical activity

-Do enough muscle-strengthening activity

-Play sports

-Walk or bike to get places (adolescents)

-Get no more than 1 hour of screen time a day (ages 2-5); no more than 2 hours a day (non-academic screen time, ages 6-17)

what is the healthy people 2030 goals for daycare/schools

-increase the proportion of child care centers where children aged 3 to 5 years do at least 60 minutes of physical activity a day

-increase the proportion of adolescents who participate in daily school physical education

-increase the proportion of schools that don't sell less healthy foods and drinks

-increase the proportion of schools requiring students to take at least 2 health education courses from grade 6 to 12

-increase the proportion of students participating in the School Breakfast Program

what is higher levels of PA associated with (6)

-Environment conducive to outdoor activity

-Access to school physical education classes

-Use of community recreation centers

-Access to physical education and school sports

-Family support

-SELF EFFICACY

what are lower levels of PA associated with (sociodemographic factors and environmental factors) (7)

-Inactivity is higher in African American and Hispanic adolescents

-High neighborhood crime

-Lack of sidewalks

-High traffic density

-Lack of access to neighborhood or school play area and/or recreational equipment

-Low family income

-Low maternal educational level

describe the 7-day recall questionnaires associated with PA assessment in children

-Correlate well with direct measures of physical activity

-May be used for assessment and for monitoring

-PACE+ Adolescent Physical Activity Measure = 2 questions

for ages 8 - 14

-Physical Activity Questionnaire for Adolescents (PAQ) =

9 items, with multiple sub-items for ages 14 - 18

what are the preferred physical activity assessment tools for peds

-Children Assessment of Participation and Enjoyment (CAPE) 55-item questionnaire to assess diversity of activities done, intensity, enjoyment, and the context of participation

-Preferences for Activities of Children (PAC) - Children rate 55 activities from 1 to 3 for 6 – 21 years of age

what is a direct measure for physical activity assessment

pedometer and accelerometer

what are the average steps girls, boys, and children with disability or chronic illness should achieve per day

-girls: 12,000 steps/day

-boys: 16,000 steps/day

-children w/ disability/chronic illness: 3,500-5,500 steps/day

describe the FITNESSGRAM

-assesses aerobic capacity, muscular strength, endurance, flexibility, body comp

-based on US norms b/t 5-17 y/o

describe the Brockport Physical Fitness Test

assesses fitness (strength/endurance) in youth ages 10-17 who have disabilities

describe the 6 min walk test and TUG

-children 3 years of age and older who are ambulatory

-AD can be used

describe the timed up and down stairs test

-8 years and older

-children may use any method of climbing the stairs

what is the goal of the lifespan approach for exercise prescriptions

development of a physically active lifestyle (embedded in daily activities, flexible, require little/no equipment)

what are the lifespan recommendations

-Physical activity opportunities in preschool

-Modifications to PE curriculum in early grades

-Extracurricular physical activity programs

-Community programs and safe environments

-Minor changes to daily routines

what are the ACSM recommendations for PA (type, screen time, freq, intensity, time)

-type: wide variety, enjoyable, emphasize positive attitudes towards PA (encourage activities that promote lifelong activity and fitness), developmentally appropriate

-screen time: less than 2 hrs per day

-freq: daily

-intensity: mod to vigorous

-time: 60 mins total

what are the strength training AAP recommendations (14)

-Proper instruction and supervision is necessary

-Child needs to be able to accept and follow directions

-Avoid competitive weight lifting, power lifting, body building, and maximal lifts until reach physical and skeletal maturity

-Pre-participation medical evaluation

-Qualified instruction and supervision

-Pair aerobic conditioning with resistance training

-Include a warm-up and cool-down period

-Resistance training 2-3 times/week on nonconsecutive days

-Any sign of injury or illness from strength training should be evaluated before continuing

-Focus on maintaining proper technique

-Start with no load/resistance, then build gradually

-Complete 1-3 sets of 8-15 repetitions in good form before increasing

-Rest 1-2 minutes between sets and exercises

-Address all major muscle groups through the complete range of motion

what is free play and its benefits

-fun → characterized by brief, vigorous bouts of exercise, with brief rest periods

Benefits = development of:

-imagination and creativity

-problem solving abilities

-motor skills

-socialization

-learning by trial and error

what are the benefits of organized sport participation (6)

-Development of physical and social skills

-increase physical activity

-Structure

-Coaching & supervision

-Safety rules & equipment

-Promotes sportsmanship & team work

what are the risks of organized sport participation (5)

-Overuse injuries, catastrophic injury

-Excessive stress and anxiety

-Focusing on sport specializatio

-Underqualified coaching

-Overbearing parents

define sport specialization

An athlete limiting participation to a single sport, which is trained for and competed in on a year-round basis with the intention of attaining top achievement in that sport

what are the risks associated with sport specialization (5)

-Overuse injuries

-inconsistent performance after age 16

-tend to quit sport earlier

-Psychological concerns: withdrawal, burnout, over-involvement, high expectations

-May limit overall development of motor skills

what are the recommendations regarding sport specialization (6)

-Participate at a level that is consistent with abilities and interest

-Avoid pressuring children to achieve a higher level of performance

-Coaches should be trained and knowledgeable in sport and developmental issues

-Be aware of the signs of overtraining and overuse injuries

-Children should undergo medical clearance prior to intensive training or specialization

-Closely monitor nutritional needs

define burnout

a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who do "people work" of some kind

how does burnout affect patients, providers, and healthcare systems

-patients: decreased quality of care, pt satisfaction, and pt access

-providers: poor provider health and increased medical errors

-healthcare system: increased provider turnover and increased costs